metricas
covid
Buscar en
Actas Urológicas Españolas (English Edition)
Toda la web
Inicio Actas Urológicas Españolas (English Edition) Identifying prognostic parameters related to surgical technique in patients trea...
Journal Information
Vol. 47. Issue 1.
Pages 47-55 (January - February 2023)
Share
Share
Download PDF
More article options
Vol. 47. Issue 1.
Pages 47-55 (January - February 2023)
Original article
Identifying prognostic parameters related to surgical technique in patients treated by robotic radical prostatectomy
Identificación de parámetros pronósticos relativos a la técnica quirúrgica en pacientes tratados mediante prostatectomía radical robótica
A. Loizaga Iriartea,
Corresponding author
, I. Lacasa Viscasillasa, S. Rey Gonzaleza, A. Santos Martina, D. Gonzalo Aparicioa,b, A. Ugalde Olanod, A. Carracedo Pérezb,c,e, M. Unda Urzaiza,b,c
a Servicio de Urología. Hospital Universitario Basurto, Bilbao. Spain
b Traslational Prostate Cancer Research Lab, CIC bioGUNE-Basurto, Bilbao. Spain
c Centro de Investigación Biomedica en Red de Cáncer (CIBERONC), Madrid, Spain
d Servicio de A. Patológica, Hospital Universitario Basurto, Bilbao, Spain
e CIC bioGUNE, Parque Tecnológico de Bizkaia, Derio, Spain
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Tables (2)
Table 1. Cohort Characteristics (n=667).
Table 2.
Show moreShow less
Abstract
Introduction and objective

The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival.

Patients and Method

Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan–Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p).

Results

Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp=0.018), preservation of puboprostatic ligaments (adjp=0.02), preservation of endopelvic fascia (adjp=0.001) and performing periurethral suspension (adjp<0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp=0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance.

Conclusions

The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival.

Keywords:
Prostate cancer
Robotic radical prostatectomy
Surgical technique
Prognostic factors
Oncologic outcomes
Resumen
Introducción y objetivo

Los factores más estudiados en pacientes tratados mediante prostatectomía radical robótica son PSA y características patológicas de la biopsia y pieza de prostatectomía. Factores asociados a la técnica quirúrgica, han sido poco estudiados y con resultados controvertidos. El objetivo, identificar todos los factores posibles de la cirugía y su relación con supervivencia libre de enfermedad y de metástasis.

Pacientes y metodo

Estudio prospectivo aprobado por el Comité de Ética, en pacientes intervenidos de prostatectomía radical robótica desde enero-2009 con seguimiento mínimo 5 años. Analizamos como posibles factores pronósticos, cirujano, tiempo quirúrgico, pérdida sanguínea, acceso fascial, técnicas continencia, preservación de fascia, bandeletas neurovasculares, cuello vesical, uretra, curva de aprendizaje y complicaciones quirúrgicas. Realizamos comparaciones univariables y emparejadas de supervivencia mediante estimación de Kaplan-Meier y long-rank tests. El nivel de significancia para comparaciones múltiples es establecido con ajuste False Discovery Rate (p ajustada).

Resultados

Cohorte de 667 pacientes con mediana de seguimiento 69 meses. En análisis univariante, el cirujano (padj=0.018), conservación de ligamentos puboprostáticos (padj=0.02), preservación de fascia endopélvica (padj=0.001) y realizar suspensión parauretral (padj<0.001) son factores de mal pronóstico para supervivencia libre de enfermedad. La preservación de fascia también afecta negativamente a supervivencia libre de metastasis (padj=0.04). Cirugías previas abdominales, próstata, tiempo de intervención, sangrado, tipo de uretra residual, lóbulo medio, acceso fascial, conservación de bandeletas o cuello vesical, no tienen significancia estadística.

Conclusiones

El cirujano y aspectos puntuales de la técnica quirúrgica son factores determinantes en supervivencia libre de enfermedad. Sólo la preservación de fascia afecta negativamente a supervivencia libre de metastasis.

Palabras clave:
Cáncer de próstata
Prostatectomía radical robótica
Técnica quirúrgica
Factores pronósticos
Resultados oncológicos

Article

These are the options to access the full texts of the publication Actas Urológicas Españolas (English Edition)
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Actas Urológicas Españolas (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos